Minimally Invasive Pelvic Exenteration for Gynecologic Malignancies: A Multi-Institutional Case Series and Review of the Literature

Bizzarri, Nicolò; Chiàntera, Vito; Ercoli, Alfredo; Fagotti, Anna; Tortorella, Lucia; Conte, Carmine; Cappuccio, Serena; Donna, Mariano Catello Di; Gallotta, Valerio; Scambia, Giovanni; Vizzielli, Giuseppe

doi:10.1016/j.jmig.2018.12.019

Cited by 43 publications

(51 citation statements)

References 43 publications

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“…Robotic technology can help the surgeon to face these challenging conditions, particularly thanks to the 3-D vision, articulated motion, improved ergonomics, and tremor stabilization. The magnified 3D vision and articulating wristed robotic instruments may allow more accurate dissection ( 27 ).…”

Section: Discussionmentioning

confidence: 99%

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Robotic Pelvic Exenteration for Gynecologic Malignancies, Anatomic Landmarks, and Surgical Steps: A Systematic Review

et al. 2021

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Pelvic exenteration represents the last resort procedure for patients with advanced primary or recurrent gynecological malignancy. Pelvic exenteration can be divided into different subgroup based on anatomical extension of the procedures. The growing application of the minimally invasive surgical approach unlocked new perspectives for gynecologic oncology surgery. Minimally invasive surgery may offer significant advantages in terms of perioperative outcomes. Since 2009, several Robotic Assisted Laparoscopic Pelvic Exenteration experiences have been described in literature. The advent of robotic surgery resulted in a new spur to the worldwide spread of minimally invasive pelvic exenteration. We present a review of the literature on robotic-assisted pelvic exenteration. The search was conducted using electronic databases from inception of each database through June 2021. 13 articles including 53 patients were included in this review. Anterior exenteration was pursued in 42 patients (79.2%), 2 patients underwent posterior exenteration (3.8%), while 9 patients (17%) were subjected to total exenteration. The most common urinary reconstruction was non-continent urinary diversion (90.2%). Among the 11 women who underwent to total or posterior exenteration, 8 (72.7%) received a terminal colostomy. Conversion to laparotomy was required in two cases due to intraoperative vascular injury. Complications' report was available for 51 patients. Fifteen Dindo Grade 2 complications occurred in 11 patients (21.6%), and 14 grade 3 complications were registered in 13 patients (25.5%). Only grade 4 complications were reported (2%). In 88% of women, the resection margins were negative. Pelvic exenteration represents a salvage procedure in patients with recurrent or persistent gynecological cancers often after radiotherapy. A careful patient selection remains the milestone of such a mutilating surgery. The introduction of the minimally invasive approach has led to advantages in terms of perioperative outcomes compared to classic open surgery. This review shows the feasibility of robotic pelvic exenteration. An important step forward should be to investigate the potential equivalence between robotic approaches and the laparotomic one, in terms of long-term oncological outcomes.

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Section: Discussionmentioning

confidence: 99%

“…When the laparoscopic and robotic approaches were compared, the only difference in perioperative parameters was operative time, with a longer duration of laparoscopic surgery ( 27 , 40 ). Bizzarri et al reported a lower median operative time in the robotic group (500 vs. 660, p = 0.04).…”

Section: Discussionmentioning

confidence: 99%

Robotic Pelvic Exenteration for Gynecologic Malignancies, Anatomic Landmarks, and Surgical Steps: A Systematic Review

et al. 2021

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“…Thus, it is a superior method compared to the conventional single-incision approach. According to Bizzarri, N. et al, minimal invasive surgery could be applied challenging surgery keeping same survival outcomes compared to conventional surgery [22]. This two-step approach also has chance to be changed minimal invasive surgery using robotic system or other advanced surgical method.…”

Section: Discussionmentioning

confidence: 99%

Intra- and Extra- Pelvic Multidisciplinary Surgical Approach of Retroperitoneal Sarcoma: Case Series Report

Song¹,

Ahn²,

Jung³

et al. 2021

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Objective: We aim to describe our experience of multidisciplinary surgical resection of retroperitoneal sarcoma (RPS), including intra- and extrapelvic approaches.Method: Multidisciplinary surgery is an anatomical approach combining intra- and extraperitoneal access within the same surgery to achieve complete RPS removal. This retrospective review of the records of patients who underwent multidisciplinary surgery for RPS analyzed surgical and survival outcomes.Result: Eight patients underwent 10 intra- and extrapelvic surgical resection and their median mass size was 12.75 cm (range, 6–45.5 cm). Using an intrapelvic approach, laparoscopy-assisted surgery was performed in 4 cases and laparotomy surgery in 6 cases. Using an extrapelvic approach, ilioinguinal and posterior approaches were used in 4 cases each, prone position and midline skin incision were shared in 1 case. All patients’ RPS masses were removed completely and 4 patients achieved R0 resection through intra- and extrapelvic surgery. Additionally, pelvic lymph node dissections or prophylactic fixation or revision of structures were conducted. The median estimated blood loss was 2000 mL (range, 300–20 000 mL) and the median hospitalization was 12.6 days (range, 9–69 days). Reoperation was needed in 2 patients (one for wound necrosis, the other for bowel perforation and wound necrosis). The median overall survival rate and median progression-free survival were 64.6 months and 13.7 months, respectively.Conclusion: RPS are therapeutically challenging based on their locations and high risk of recurrence. Considering that, intra- and extrapelvic surgical approach could improve the macroscopic security of the surgical margin.

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“…Data are starting to emerge on the safety and feasibility of the MIS approach, particularly using robotic surgery, to carry out pelvic exenterations for recurrent cervical cancer [133,134]. The main benefits are shorter hospital stay, less postoperative pain and less intraoperative blood loss [133].…”

Section: Pelvic Exenteration For Recurrent Cervical Cancermentioning

confidence: 99%

Laparoscopic and Robotic Surgery for Endometrial and Cervical Cancer

et al. 2021

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Minimally Invasive Pelvic Exenteration for Gynecologic Malignancies: A Multi-Institutional Case Series and Review of the Literature

Cited by 43 publications

References 43 publications

Robotic Pelvic Exenteration for Gynecologic Malignancies, Anatomic Landmarks, and Surgical Steps: A Systematic Review

Robotic Pelvic Exenteration for Gynecologic Malignancies, Anatomic Landmarks, and Surgical Steps: A Systematic Review

Intra- and Extra- Pelvic Multidisciplinary Surgical Approach of Retroperitoneal Sarcoma: Case Series Report

Laparoscopic and Robotic Surgery for Endometrial and Cervical Cancer

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